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It is important to educate and equip the orthopaedic community with tools to address health care disparities and improve orthopaedic specialty recruitment for racial minorities. How patients and providers are affected by systemic racism in healthcare and what that means in orthopaedic surgery, methods to identify bias and improve access to orthopaedic care for racial minorities, and how to structure a program and department environment to encourage and promote diversity are important topics of discussion.

Background Despite interest among North American orthopaedic residents to pursue rotations in resource-limited settings, little is known regarding resident motivations and impact on host surgeons. Methods Surveys were distributed to North American orthopaedic surgeons and trainees who participated in international rotations during residency to assess motivations for participation and to orthopaedic surgeons at partnering low- and middle-income country (LMIC) institutions to assess impact of visiting trainees. Results Responses were received from 136 North American resident rotators and 51 LMIC host surgeons and trainees. North American respondents were motivated by a desire to increase surgical capacity at the LMIC while host surgeons reported a greater impact from learning from residents than on surgical capacity. Negative aspects reported by hosts included selfishness, lack of reciprocity, racial discrimination, competition for surgical experience, and resource burdens. Conclusions The motivations and impact of orthopaedic resident rotations in LMICs need to be aligned. Host perceptions and bidirectional educational exchange should be incorporated into partnership guidelines.

The objective of this study was to examine the routine pathologic examination of surgical specimens obtained during fasciectomy for Dupuytren contracture.A total of 376 consecutive patients who underwent surgical limited fasciectomy with the excised tissue sent for histopathologic evaluation were identified. Patients were excluded for miscoded procedures, cases where no tissue was sent for pathologic review, and excisions of nodules only. Repeat surgeries in the same patient during the study period were excluded. The rates of concordant, discrepant, and discordant diagnoses were reported. Discrepant diagnoses were defined as different clinical diagnosis and pathologic diagnosis that did not change clinical management. Discordant diagnoses were defined as a different clinical diagnosis and a pathologic diagnosis that altered the treatment plan. The reference standard for final clinical decision-making was the pathologic diagnosis.The prevalence of concordant diagnoses was 97.1% (365 of 376), of discrepant diagnoses was 2.9% (11 of 376), and there were no discordant diagnoses. Of 376 patients, 43 underwent previous surgical fasciectomy before the study surgery, and pathologic examination was obtained in 10 of these patients. All 10 patients had concordant diagnoses.Our results suggest that routine pathologic examination did not alter the future treatment plan for patients who underwent limited fasciectomy. Discrepant diagnoses were encountered infrequently, and rarely in the setting of revision fasciectomy. Discordant diagnoses did not occur. Given the cost associated with pathologic evaluation, this raises the question of whether routine pathologic evaluation is necessary for Dupuytren surgery, where the capability of the treating surgeon to make a clinical diagnosis accurately may render confirmatory pathologic assessment redundant.Diagnostic II.

The COVID-19 pandemic has touched every community and every part of the healthcare system, including the introduction of several new challenges for the healthcare providers and trainees. Studies have examined some of the difficulties that COVID-19 poses for education – for the faculty, residents, and other healthcare providers outside the hospital or self-quarantining in preparation for redeployment. This article describes the Harvard Combined Orthopaedic Residency Program’s (HCORP) proactive educational response to the instructional training gap created amid the COVID-19 pandemic. Herein, we introduce a new educational vehicle that allows for the smooth and reliable delivery of pediatric orthopedic didactics and trainee educational engagement for years to come. In addition to exploring how a virtual curriculum was used successfully, this narrative explores novel benefits made possible by the digital platform including the ease of involvement of trainees in disparate locations, the creation of a comprehensive digital archive of educational material, and the ability to extend the educational experience beyond HCORP trainees exclusively.

This paper proposes a methodological framework for examining the distributional effects of alternative agricultural policies in less developed economies. The framework combines disaggregated household models with an explicit modelling of the linkages between product and factor markets.

This paper measures linkages between farm and non-farm activities in rural Mexico using a multiplier model based on social accounting matrices (SAMs) from survey data for five villages at differing income levels and in different agro-ecological and market zones. We extend this analysis to a "mini-region" that includes three villages and their larger administrative center. By applying a constrained SAM multiplier model, the paper examines how economic shocks in rural areas affect non-farm incomes in rural villages, in neighboring rural towns and in larger regional cities. Two exogenous shocks on non-farm activity are examined: pure income transfers; and increased agricultural productivity. Experiments assume a perfectly inelastic supply of agricultural goods, as in "semi inputoutput" and "economic base" models. Results show that most farm-nonfarm diversification is between villages and regional urban centers. The largest linkages are with markets outside, rather than within, villages: an experimental $100 increase in exogenous income is linked with a $2 increase in non-farm production but a $51 increase in demand for imported goods. This is evidence of "agriculture-demand-ledindustrialization" and explains growth of regional urban centers, which now accounts for most of Mexico's urban growth. Our analysis highlights the complex economic interactions between villages and towns in what probably is a mutually beneficial relationship broadly consistent with comparative advantage. Results suggest that increasing the income of village households can stimulate growth of the rural non-farm commercial activity in towns and small cities. Comparisons across villages suggest that investments in rural infrastructure can facilitate these commercial linkages between villages and towns.

The rational formulation of American foreign policy is rendered extremely difficult by the great number of factors which must be taken into account by the decision- makers. These are beyond the capacity of any human brain, or even team of brains, to assimilate, evaluate, and reduce to forms upon which sound policy can be based. A weighted framework or model is needed, and some mechanical support for human thinking which would rationalize initial foreign policy estimation electrically. Such a device will also permit gaming. As a preliminary blueprint for this proposed device, The World Analyst classification system is used to divide na tional power into ten "factors": geographic, demographic, po litical, foreign affairs, economic, industry, transportation and communication, scientific, armed forces and biographic. To evaluate individual elements of national strength and weak ness, these are cross-categorized on game boards in five panels: immediate national power, potentials for national power, de struction of such elements, aggressions between nations other than the United States, and acts of aggression towards the United States. Using a model of this sort a trial balance can be obtained between nations, and policy can be tested in advance.